Today’s Health Care Checkup – GOP Plans Under the Spotlight

The GOP has much more to lose than Obama or the Democrats with this hypothetical meeting. The GOP needs the status quo to carry on so they can take pot shots at bills that are as yet unrealized. Being forced to put something concrete on the table puts them in the same position as the Dems, trying to squeeze savings out of health care without ticking off the public.

http://www.political-buzz.com/

B-but the not-at-all-cowardly Jay Newton-Small says the teabaggers are scared of reform because their intentions are so good! What is one to make of it all?
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Seriously, thanks, Kate. There is a shocking wealth of information here & an interesting foil to this weekend’s Nashville nutter convention.

Kate Pickert:
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Thanks for this reporting, these links, the anecdotal stuff from the conference –this is great.
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Any word on what “fixes” the House is negotiating into the “sidecar” for Senate reconciliation?

Kate Pickert:
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Oops…one correction to your post is obviously in order:
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There is simply no way, for example, to extend coverage and save entitlement programs without some combination of those oh so popular things called taxes and cuts, unless the Federal government begins to set prices for the most inflationary segments of both private and public domestic health care markets, and allows immediate drug importation from foreign markets where pharmaceutical prices are lower due to such government controls.
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There, fixed that for you, Kate Pickert.

I’m all for scrutinizing the GOP’s Health care plans, but before we get ahead of our selves in shining the spotlight on their plan, what’s the Democrat’s plan look like.

For all these months, we have not seen the actual plan that has been ironed out behind close doors by Obama and the handful of Democrat leaders. We’ve seen and heard the early iterations, but alot has changed since the bills passed both houses.

Not only have we not seen it the new Democratic version, but they have been unable to explain it….

So, let’s see what’s been negotiated by the few Democrats and then let’s see what the GOP has on the table and then let’s compromise.

But let’s hope this isn’t just an grand attempt to posture for political points from both parties….

Interesting that Obama wants to do this out in the open only after it’s apparent that there are political points to be gained from it (for him). So predictable.
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Wish he would’ve done the same with the back-door Big Labor and Big Pharma deals.

“If you’re asking yourself why this isn’t as easy as it sounds…”
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Actually, I was asking myself how much longer we can survive as a republic if we keep having to pretend that any contrived Republican “unified health care plan” has any relative importance at all.

Sounds like the MSM is trying to come to the rescue of Obamacare. I expect it will be like AP assigning approx 30 reporters to go through Palin’s book and try to find errors. AP didn’t assign any reporters to examine either of Obama’s books. I think that might indicate a little bit of bias.
MSM will go through everything the Republicans might suggest at the meeting and try to show it won’t work.
Bottom line, it will be Obama and the MSM against the republicans and approx 65% of Americans citizens who do not want Obamacare. They want real HCR not the monstrosity that Obama and the democrats have put together.
I guess Obama and the democrats didn’t learn anything in Massachusetts, Virginia or South Carolina.
I think they will get the message at election time.

Lol! Let me know when you come back from fairy land.

3x why does it always have to be about your paranoia. Come up with some solutions. By the way, Massachusetts has universal coverage that Brown supported.

You’re so savvy!
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What do you do with all of that savviness –I mean besides snidely shoot down the policies adopted by the rest of the developed world to stop health care from eating 20% of dwindling GNP?
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You know what?
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You’re so in touch with reality that you don’t even need to respond with an argument or a rational thought.
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Just give yourself a nice snicker and smirk like you’ve seen Chuck Todd or David Gregory do a million times, and then you can feel just as superior as they do (minus the fact that you’re not a multi-millionaire, like them).
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See? Wasn’t that easier than doing the heavy mental lifting required to figure out which one of
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A) raising taxes to cope with the government’s 40%+ share of $4.5 trillion dollars a year in 2019 (link to Reuters on CMS report),
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B) cutting benefits that keep people’s elderly moms and dads alive so that they stay more ill and in pain, and die faster, or
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C) freezing the growth in prices on the most inflationary health care markets of any OECD nation, while legalizing for Medicare and Medicaid what people are starting to do over the internet every day –buy their drugs as cheaply as the Canadians do since their government started to negotiate prices on its citizens’ behalf.
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But why am I wasting your time with all of that wonk drivel when you can come back at me with a smirk and say “Not…Ga…Happen“?
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I guess I just can’t let an opportunity to amuse fine Americans who know their political reality like you with my boring, old, naive “caring about my country” crap.
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So have yourself a nice chuckle about “fairy land” at my expense, amigo, while your country falls apart. Stay proud, son.
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America really needs less people like me, and more people like you interested in politics.

As a fairly economic right-leaning person, I find the Republicans proposals often incoherent. But there are some good ideas out there. Sometimes politics gets in the way.

A central problem with our healthcare system is the third-party payment system. That is, people not only aren’t paying for their own health care, they aren’t even buying their own insurance. Either their employer or some government agency is. As a result, there is virtually no downward pressure on cost. The doctor has many incentives to perform excessive testing, while the patient has no reason to ever say no to anything. Moreover, most employer-provided plans are comprehensive, meaning they cover everything including routine doctors visits with minimal co-payments. Hence, most people have no idea how much their health care bills run to, and no reason to find out. Instead, the hospitals feel free to overcharge, and the third-party payors are in no position to deny coverage for anything. This goes not just for insurance companies, but also for Medicare – precisely the reason for proposals to establish expert panels to eliminate “wasteful” procedures. The government as third-party payor is in exactly the same bind as the insurance companies. The patient isn’t paying the insurance rates, and hence has little incentive to say no to any treatment, and will scream bloody murder if the third-party payor does, whether the payor is a private insurance company, or a government plan. (Incidentally, this problem would doom any “public option” plan as well).

Other problems with employer-based insurance include job lock, the inability to change jobs without losing insurance, as well as the profoundly disturbing problem of people being dumped by insurance companies after they get too sick to work and lose their jobs.

For this reason our first priority in reforming healthcare should be dismantling the employer-based, third-party payor system. The reason this system continues to exist is because the tax code provides a tax incentive to employers, but not to individuals buying insurance. Consequently, it is cheaper for most individuals to let their employers pay for it than to buy it themselves.

Removing the employer tax deduction should be point one. Yes, it increases taxes, but it also makes them flatter. Republicans shouldn’t be in favor of riddling the tax code with special deductions and credits.

Point two should be repeal of McCarran-Fergeson, the 1945 law which split insurance markets into individual state markets (not to mention exempting insurance from anti-trust laws). This law has the perverse effects of limiting competition to a collection of state-wide cartels, and preventing people for taking insurance with them across state lines when they move. For people with pre-existing conditions, the inability to move without losing insurance can have profound personal consequences. (Imagine not being able to live in the same state as your loved ones).

Like the job-lock problem, the Democrats proposed solutions are ass-backwards. Instead of dismantling the employer-based insurance system, they reinforce it by mandating employers offer coverage. Instead of dismantling McCarran-Fergeson, allowing people to buy insurance from anyone they want, they propose setting up complicated insurance “exchanges” with restrictive rules that limit choices. Instead of making it possible for people to keep their current insurance policies, they force insurance companies to take people with pre-existing conditions. Which, in turn, necessitates an individual mandate (otherwise, nobody would buy insurance until they were already sick).

Rather than force insurance companies to take people with pre-existing conditions – people who have often lost insurance by losing their job, or moving across state lines – I think it makes more sense for there to be one national insurance market, where individuals buy their plans directly, and can keep their policies for life.

Point three should be to make sure that insurance companey’s can’t drop patients who are already sick, but NOT force them to take new customers who are already sick. You don’t keep paying premiums after your car is totaled, but neither can you take out a policy on an already-totaled car.

Lastly, an insurance company should not be allowed to deny coverage *after the fact* due to a pre-existing condition, unless they can prove by perponderance of the evidence in a civil court that the patient deliberately concealed an illness in order to obtain coverage. (or unless they can prove the patent commited insurance fraud). It makes little sense to have someone paying into a policy for years and then suddenly find that they aren’t covered. That is called breach-of-contract. If the insurance company is going to deny coverage, they need to do so at the very beginning. Not after the person has been paying them for years.

hazelmeade,
Thanks for the very thoughtful post.
You express some very good points and ideas. Keep up the good work. We don’t often get that on this site.

Apr,
Could you give me a rational reason for AP assigning all those reporters to investigate Palin’s book and none to investigate Obama’s books?
If you could it would be of tremendous help to my paranoia.

Thank you hazelmeade.
You do a good job of showing how a third-party payment system can place added burdens on employers and restrict the insured’s mobility and options.
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I would like to know your thoughts on government administered single-payer system vs. a private “national insurance market”. Countries that use the former avoid many of the pitfalls you describe, while one would expect that a competitive national market would produce a better product at a cheaper cost. Of course, competition is key, we would need to be cautious that private companies don’t act in collusion to set prices and procedures or that the market doesn’t become dominated by a small group of influential players (or cos become “too big to fail”).
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Is the answer, in your opinion, a private national market subject to federal oversight- perhaps an independent non-partisan panel review? We’d appreciate any insight.

Politico’s Michael Calderone has a rational reason:
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While 11 staffers sounds excessive, it’s true that the AP’s deep reserves allow for reporters with specific areas of expertise — such as the Alaska pipeline or incidents from the campaign trail — to address a handful of pages dealing with those specific topics, while not necessarily dropping everything to read the entire book. (link)
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I’m not trying to be snarky, but isn’t this “much ado”? Factcheck.org assigned 6 staffers to Obama’s State of the Union address- it doesn’t imply anything, IMO.

Well, technically speaking a single-payer system IS a third-party payment system, and it does suffer from the cost problem I mentioned above. Individuals have little to no incentive to restrict their use of health care services. Although many countries have limitations on malpractice liability. In Canada, for instance, medical awards for non-pecuniary losses are generally limited to $300,000, it is much harder to prosecute such cases, and losers are responsible for paying up to 2/3rds of the winner’s legal expenses, which tends to discourage claims.

Ultimately, in a single payer system someone does have to ration care, even if it comes in indirect forms. For instance, Canada pays relatively low salaries to doctors and nurses, resulting in chronic shortages of medical professionals, resulting in the waiting lists everyone knows about. Secondly, Canada has been late in adopting many new medical technologies such as CAT scan and MRI machines. By restricting spending on salaries and equipment, costs are controlled, but it ultimately results in overall a lower standard of medical care. Also, it should be noted that wealthy Canadians are often able to skip the wait lists by going to the US and paying privately.

Also, it’s worth noting that if drug reimportation were permitted shortages of drugs would rapidly develop in Canada and other price controlled systems, since the drug companies only agree to sell a specific amount at the reduced price. Those price controls only survive because we ban reimportation. As soon as we lifted that ban, Canada would have drug shortages.

hazelmeade:
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I’d just like to first say thanks for your input, we don’t normally hear relatively cogent rightists’ arguments for market fundamentalism applied to health care here.
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You’re correct that Canadians pay relatively low prices for health care consumables like physicians’ visits, hospital stays, prescription drugs, laboratory tests and medical supplies, but, of course, that’s only relative to the United States.
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Canada isn’t, of course, the only first world nation with a continuance of third-party payment systems and half the cost per person compared to US health care.
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Germany spends half the amount that we do, France also, Switzerland, Japan, Italy, Spain –the entirety of the wealthy world literally spends less than half the cost of each health care unit than we do, even though there are third-parties (either the state or private insurers) who pay for all the care that citizens need.
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Surely you’re not suggesting that Japan is “behind” in medical technology,are you? Similarly, it’s not credible to suggest that Germans are suffering from substandard health care or scarcity rationing. The fact is that the people of these nations are not waiting abnormally, not denied care, not rationed to death, and not upset or dissatisfied in any way with their systems. In fact their system rank higher than ours in World Health Organization evaluations. In Japan, for example, folks live longer than us, are an older population than us, see their doctors three times more often, and have more MRI’s than we do. They don’t have a single-payer system (their insurers are private), but they do have a strong system of transparent price controls through an empowered government ministry.
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The reason that these nations can accomplish these things is because they’ve implemented nation-wide price controls in addition to third-party payers. We have the worst of all worlds, in that we have third-party payers, but no price controls. That’s why we’re going to spend over 20% of our GDP and $4.5 trillion on health care come 2019 (according to USHHS), and why we currently pay a bubble price of roughly $7300 per person compared to Japan’s sensible $3000 or so per person.
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When you assert that the central problem for US health care is that “people not only aren’t paying for their own health care,” not only are you positing a market fundamentalist theory, i.e. that the treatment self-rationing of working and middle-class individuals (not the affluent or the poor) will guarantee decreases in the price of health care, but you’re essentially contradicting the empirical results of every other working health care system in the developed world.
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When you say:

By restricting spending on salaries and equipment, costs are controlled, but it ultimately results in overall a lower standard of medical care.

, isn’t that really an ideological premise not borne out by the facts –not just about Canada, but about every first world nation?
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When you assert:

Those price controls only survive because we ban reimportation. As soon as we lifted that ban, Canada would have drug shortages.

, aren’t you making a grand theoretical assumption? What data exists that shows this to be an inevitable outcome? I haven’t found any, myself.
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Just so that you understand my position, I’m not arguing for the Democrats’ plans, I think that they’re counter-productive and foolish. I agree with you that the employer-provider system is an irreparable failure. You are correct that almost all of the OECD countries I have mentioned have very, very strict anti-litigation systems in place. You certainly have ideas, such as the implementation of a national health insurance market (subject to strict Federal regulation), that I would support –no matter who was arguing for them.
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But it seems as if you’re missing the entire OECD world’s success by fetishizing the Canadian system’s (a system that their citizens love, by the way) few faults, and lauding a quality of care that the US system makes available to fewer and fewer middle-class Americans –a quality achieved by countries like Japan and Germany at literally half the cost.
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These aren’t theories about how these countries should work, the data proving that these systems do work is available (link to some comparison pricing per health care unit) . CT imaging scans in Germany cost $319 to our public/private range of around $1000 to $1800. So it goes for virtually every single health care unit: Americans are getting a bad, bad deal for their health care dollars.
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So here’s the bottom-line question I’ll leave you with, hazelmeade:
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Even if your assumptions about what causes health care costs to rise line up with a particular school of economists’ models, and the theory of individual care-rationing might appeal to certain traditionally American-held Protestant values with respect to “waste” and “efficiency,” doesn’t it strike you as unreasonable not to go with what we know works in other first world nations?
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Shouldn’t we just be practical about the problem, and not first look to some imaginary, perfect market for our solutions? Shouldn’t we just steadily and explicitly move away from our failed, business-encumbering system toward a nation-wide, third-party payer system with the purposeful power to negotiate (set) health care prices on behalf of 300 million Americans?
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Even if it might not be perfect, and even if it might not allow certain Americans to crow about their superiority, and even if it’s the opposite direction from ideological belief in the perpetual superiority of “markets,” why shouldn’t we just do what we know works, hazelmeade?
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Thanks so much for reading and considering this.

Thanks hazelmeade, Stuart.

Stuart, thanks for so clearly explaining the difference between our so called system and others that are more efficient and deliver better quality. I wish our President and legislature had had the fortitude to try for the best system instead of what they sort of, maybe ended up with. As you stated, there is so much data to support better ways of delivering health care. The sad thing is superior health care reform could have been more easily explained and understood. The middle class could have seen direct benefits to them.

Thanks to you folks for taking the time to read these long, overly-explicit posts.
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I’m trying to make them less verbose, but it’s difficult when there’s so much to describe, explain and question.

3x: I respectfully must say, I don’t care. Assignment of reporters does not seem to be some sort of conspiracy so I just don’t care.

Thank you hazelmeade and stuart, good posts from both. As a physician, I have more than a passing interest in this subject. There surely can be a middle ground compromise between reasonable people and I maintain hope that it will happen. Tort reform is the elephant in the room that scares Democrats the most…too bad, because it is a significant contributor to escalating health cost. When physicians are required to pay 100k+ for malpractice insurance, those expenses are passed on to the patient…tort reform MUST be addressed before the majority of physicians will lend their weight to any proposed bill. And in closing, let me also suggest that whatever bill surfaces, it should be MANDATORY that members of congress be required to participate in the same program they provide the public….No exceptions allowed. A bill with this provision, just MIGHT pass the smell test.

earljr1:
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Thank you for reading.
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Let me just say that elected Democrats are different from liberals, and that liberals aren’t afraid of tort limits in the slightest, as long as we’re talking about specific proposals, and not some nebulous “reform”.
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What we object to is the notion put forward by Republicans that the cost malpractice insurance is the reason why Lipitor dosages are priced at $53 in France, or $48 in Germany vs. the $125 to $334 we pay in America. It’s not. MRI’s aren’t twice as expensive here as they are in Japan because of physicians’ fear of lawsuits, nor will award caps start to bring down the price of $8 a gel-cap Tylenols or $10k a night beds in hospitals.
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Liberals aren’t unaware of litigation abuse, we live in New York, and see the commercials on TV for 1-800-SUE-URDR all the time. We’re just in possession of the facts that tell us it’s not going to do much in the way of bringing down the price of medical equipment to what they pay in Spain or Holland (or everywhere in the first world).
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Also, when it comes to Congress (or all Federal employees, for that matter), we’re some of the first to demand that they share the same health care system as the American people. Not an issue for liberals, just for elected Democrats.
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I hope that the difference is more clear to you now.

More than 95% of trial lawyer (ambulance chaser) political donations go to Democrats. That’s why Tort Reform was never part of the grand plan. That’s a big reason why healthcare bills will always be high.

That’s a big reason why healthcare bills will always be high.
No, that’s a partisan talking point, i.e. a “lie”.

I disagree, stuart, it DOES contribute quite significantly, it is perhaps the primary reason that most conservatives are suspicious of ANY health care reform forged by the Democrats. If there is to be bi-partisan cooperation, then bring the whole thing out in the open. Total and complete transparency…whatever happened to that promise, anyway? I think it was shameful how this current bill was put together. In total secrecy……We were promised something quite different! Tort reform MUST be addressed. If not, then it is my hope that Republicans dig in their heels and FORCE debate on this issue. ( I am an independent voter, by the way)

Pinto,
Do you really believe that hogwash? It’s comical that they could not come up with a better excuse than that. Like JK they must think most American are stupid.
Let me know when you can come up with an answer that makes any sense.

Stuart,
Tort reform by itself will not solve the cost problems of healthcare. But it is a substantial cost driver and any HCR without Tort Reform is a joke.
If the President really wants bipartisanship he should agree to Tort Reform immediately which would create the environment to start work towards a real HCR bill. The President and the Democrats still want their bill passed. They have not given up on the idea that they can have HCR without any real Republican input.
I agree we need HCR but it will not be achieved until Obama realizes that it will only become law if both Democrats and Republicans support it and therefore he must truly bring Republicans into the tent as a partner in these reforms.
I don’t believe he fully realizes this yet. If he doesn’t soon we will not have HCR.

Apr,
If you would read the other posts from knowledgeable people in addition to Stuart’s posts you would realize that quality does not go up with HCR in the current bill. Read hazelmeade and several other thoughtful posts. What you don’t realize is that we all want real HCR but many of us honestly do not think Obamacare is a good reform. Good reform will only take place if Obama stops politicking and brings the Republicans in as full partners in the process. Regardless of what liberal/progressive blogs etc say, this has not been done. Its been a partnership of we win you lose. That has never and will never work.

3x please take time to read Ezra Klein’s article about the Rep initiatives already included in the Senate bill.
http://voices.washingtonpost.com/ezra-klein/2010/02/five_compronises_in_health_car.html
Please don’t dismiss it as a liberal rant. Ezra Klein is one of the few experts on HCR. Tell me exactly what the Republicans have to offer.
I don’t think I ever stated I was happy with the Senate bill. My hope was for single payer, extension of Medicare, or at least a strong public option. There is just too much data from other countries that show how inefficient, costly, and lacking in quality are current system is.
It is hard to compromise with the Reps who have gotten some of what they wanted but still allow the HCR bill to be demigoged by not disputing things like “death panels”, socialism charges, etc.
Tort reform is fine. We had reform in CA and it has done little to diminish doctor’s liability premium. Those costs are still past on. I don’t know if you read a previous post i did about my 10 years experience with a really good health insurance program instituted by CA for small businesses. At one point it insured 200,000 people in private health insurance. There was no health underwriting and no recission. After it was removed from state oversight, the health ins. industry slowly dismantled it. All those people were on there own.
The Reps push private savings accts. My nephew has a private savings acct, but because he has diabetes any insurance coverage he can get is exhorbitant. He lives on the border so he goes to Canada for care and medications.
Allowing interstate purchasing is fine but it has to be accompanied by antitrust laws and oversight so the ins. cos. don’t take shelter in states with slack regulation, like banks and credit card companies do.
No plan will be any good without preventive care, keeping people out of emergency rooms for everyday health care, and working with hospitals and physicians to keep costs in control.
We need to be able to have a plan that can negotiate pharmacutical costs and reimportation. We can no longer allow recission or denial of people with pre-existing conditions. The “law of large numbers” works.

Apr,
You should read hazelmeade’s very thoughtful and knowledgeable post 9.1 It will help you understand that quality does not go up in a nationalized HCS.

“Ultimately, in a single payer system someone does have to ration care, even if it comes in indirect forms. For instance, Canada pays relatively low salaries to doctors and nurses, resulting in chronic shortages of medical professionals, resulting in the waiting lists everyone knows about. Secondly, Canada has been late in adopting many new medical technologies such as CAT scan and MRI machines. By restricting spending on salaries and equipment, costs are controlled, but it ultimately results in overall a lower standard of medical care.”

Whether Obamacare is good or bad we should use facts not misleading data in determining our HCR.

stuart,

Thank you for your reply.

I think you misread my post however, because I didn’t state that canadians pay less for doctors visits, etc. By definition, that is paid for by the Canadian medicare system. What I said is that Canada’s government pays lower salaries to it’s medical professionals. A fact which is directly responsible for the shortage of medical professionals in Canada. Which results in the wait lists, not to mention periodic doctors and nurses strikes. And if waiting on a list while sick isn’t a lower “quality of care”, then what is?

It’s erroneous to assume that all European health care systems are “single-payer”. Germany’s is a public-private mixture, with employer-based insurance and mandates, similar to Obama’s bill. In fact, in certain ways, they might actually be freer markets.

In the US, the AMA maintains a monopoly over medical licensing that numerically limits that number of people who can become doctors each year. Moreover, regulations on what procedures can be administered by nurse practitioners further help to limit supply by requiring doctors to perofrm more procedures. Other countries do not have numerical limits on medical licensing and have looser restrictions on what nurse practitioners (or the equivalent) may do. Moving to a stanardized test rather than a numerical limit for licences would increase the supply of doctors.

Another thing is that in many European countries it’s possible to buy drugs over the counter which would require a prescription in the US. So Americans have to make an appointment with a physician, and pay $100 co-pay for the visit, just to be allowed to buy a drug that can be had over-the-counter in France.

I don’t believe that any economist would consider it a controversial statement to say that price controls cause shortages. This is a broad result from observation of the effects of price controls on supply throughout economies going back back to ancient Rome. Any time you impose a cap on prices below the market price, you are going to (at least) reduce the profitability of supplying that product, if not render it unprofitable. If the prices are extremely high it is (normally) because that thing is in short supply or high demand. The high profitability attracts investment to producing more of that thing (whatever it is), eventually bringing proces down. If you cap the price you destroy that price signal. Investors don’t direct resources towards production of that product, and you end up with a shortage. This is true even if the price cap doesn’t actually make the product unprofitable. Just limiting the profit to a small amount will skew the attractiveness of the investment so fewer people will bother trying to put money into it.

But this is exactly what’s wrong with the third party payment system. The fact is that because the “consumer” (in this case the patient) has no idea what his health care costs, and no reason to care, there are no negative price signals in the system. The only one with the incentive to say “no” is the third-party payer: either the government or an insurance agency. But if either one threatens to cut payments or deny treatments, patients will freak out. See Medicare. The problem the government has with cost spiraling in Medicare is the same one the insurance companies have. The reason insurance rates are rising is the same reason that entitlement spending is rising: lack of negative price signals because of the third-party payment system.

The only way (short of state-based rationing) to get costs under control is going to be to restore the price signals by having consumers buy their insurance plans directly. If you want to help the uninsured, or the poor, it would make more sense to give them vouchers for high-deductible plans, or perhaps HSAs, so they have an incentive to shop for routine care.

Hazelmeade,
Again thanks for the Post,
Your comments add a lot to this discussion. You show a lot of wisdom.
As a senior, I believe true wisdom is a combination of Education and Experience. If you don’t have both you have limited wisdom.
Too many of our young people do not understand this. They think they know everything but because of their lack of experience their knowledge is incomplete.

3x: I have read all of hazelmeade’s and other serious posts. Although I usually but not always agree with Stuart, the points I have been making are my own. I am sure these points have been made here before. Here are some costs and outcomes.

http://sanders.senate.gov/files/SinglePayer-factsheet.pdf
Health care cost per person US $7129
Canada $3895
Australia $3763
About double other industrialized nations
US has one of lowest life and disease expectancy of other industrialized nations.

29th infant mortality
http://www.cdc.gov/nchs/data/databriefs/db23.htm

In last 20 years administrative personnel have grown to 25 times the number of physicians, mostly to process insurance paperwork.
Private insurance wastes more on bureaucracy. Us could provide health care for all for what is spent on this bureaucracy.
Dihttp://www.medicalnewstoday.com/articles/8800.phpd

As far as rationing, it already exits and in some cases should. Decisions for treatment should be between doctor and patient. Now insurance companies make that decision, by denying treatment or denying insurance for preexisting conditions or through recission. Almost all health insurance plans require requests mediation or arbitration of treatment requests be made by the insurance only. They have the last word. Always read you health insurance policy jackets carefully.
http://www.npr.org/templates/story/story.php?storyId=106168331that decision, often by denying treatment or by denying individuals insurance.

And, please do not ignore the facts about tort reform. Many have stated here that they have no objection to tort reform but it will save little. See Californias experience.

Have you read the Ezra Klein article in the WP that I pointed you to.
http://voices.washingtonpost.com/ezra-klein/2010/02/five_compronises_in_health_car.html
He explains how many Republican requirements have been included in the Senate plan.

3x, I don’t claim to be an expert. However, after spending the last number of years of my working career in the health insurance industry, I do have a lot of life experience in its shortcomings, both anecdotal and factual. My wish is for single payer to be part of our health care system because it is the most efficient, has the best health and cost outcomes, and is the most humane.
Please consider what I have posited.